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Pediatric Response by Petrina Fadel

I am writing to you to request that you withdraw or rescind the newest
2012 AAP Circumcision Policy Statement. Below I have critiqued for you some of the serious problems with this new statement.

The Abstract states on page 585 that “health benefits are not great enough to recommend routine circumcision for all male newborns”, but this is not repeated even once in the long text on pages 758-785.
Other long columns favoring circumcision are repeated over and over again, on pages 761-762, 770, 775-776, and 778. The 1999 AAP Statement was 8 pages long (pages 686-693), but this diatribe against living with a foreskin goes on for 28 pages. There is almost the feeling that AAP physicians hope that if they repeat something over and over again, eventually it might become true.

The AAP concludes on page 778 that “the health benefits of newborn male circumcision outweigh the risks”, and yet on page 772 the AAP admits that “the true incidence of complications after newborn circumcision is unknown”. If one doesn’t know how often complications occur, then one can’t make the judgment that the benefits outweigh the risks! The AAP lacks the evidence it needs to make such a claim.

The 1999 Statement studied 40 years’ worth of research, and the 2012 studied only selective research since 1999. Only 1031 of 1388 studies were accepted to look at. Balance might have been found in the 357 studies that were omitted, but the AAP was not seeking balance. The AAP statement goes on ad nauseum about alleged “benefits”, to the point of fear-mongering that something will go wrong if an infant isn’t circumcised. It’s a high pressure sales pitch to try to get the American public to buy the circumcisions that AAP and ACOG doctors are selling. This is in direct contrast to Europe, where circumcision is uncommon and the health of European children equals or surpasses that of American children.

No studies on ethics were included in this statement, and it is clear that the rights of the child and how a grown man might feel about HIS foreskin being stripped from him were never given any consideration at all by the AAP. These are major issues, and even more important than many of the other minor issues the AAP discusses. Material was provided to the AAP to study this aspect of circumcision, but it was ignored. With one bioethicist on the panel, you would have thought that the AAP might at least have given the ethics of circumcision a cursory examination, considering that they were provided with many sources showing the emotional distress many men feel. Ethics and mental health, however, nowhere enter the picture for the AAP. Respect for the bodily integrity of another person were not included, and medical ethics were thrown out the window as infants were thrown under the bus.

Financing studies weren’t included in the studies, but the AAP did its best to push financing repeatedly for third-party reimbursement of non-therapeutic circumcision, at the expense of taxpayers during a time of budget crises. Those with private insurance would see premiums and medical costs rise. The cost for circumcision on page 777 ranges from
$216 to $601 per circumcision in the U.S. In 2010, the in-hospital U.S. circumcision rate was 54.7%. Thus, 45.3% of newborn males left
the hospital genitally intact. If the AAP were to convince parents of
these 45.3% to circumcise (as they are attempting to do in this 2012 statement), then there would be 45.3% of roughly 2.1 million baby boys that could be an additional income source for physicians. (Remember, don’t consider the ethics!) This would be an additional 951,300 male infants to profit from. At prices the AAP quotes, this could mean an additional $205,480,800 to $571,731,300 for doctors who circumcise.
This is no small sum, and as Thomas Wiswell, M.D. stated on June 22,
1987 in the Boston Globe, “I have some good friends who are obstetricians outside the military, and they look at a foreskin and almost see a $125 price tag on it. Each one is that much money. Heck, if you do 10 a week, that’s over $1,000 a week, and they don’t take
that much time. “(Lehman 1987) Money like that would certainly help
doctors make their mortgage payments and their car payments, pay for vacations, etc. – a “benefit” that the AAP failed to mention. Under Literature Search Overview, it is understandable why AAP physicians might consider it important to investigate “What are the trends in financing and payment for elective circumcision?”

No studies on the anatomy and functions of the foreskin were included.
This is surprising, since it would seem like common sense to consider what the functions of any healthy body part are before amputating it.
Probably since the male AAP Task Force members are all circumcised, this idea was difficult for them to grasp. Only one study on the sexual impact of circumcision was included, and this from Africa.
Other studies were ignored or discounted. “The effect of male circumcision on the sexual enjoyment of the female partner”, which appeared in BJU INTERNATIONAL, Volume 83, Supplement 1, Pages 79-84, January 1, 1999, is not mentioned. Nor is the newest Danish study that was publicized on November 14, 2011 – “Male circumcision leads to a bad sex life” – “Circumcised men have more difficulties reaching orgasm, and their female partners experience more vaginal pains and an inferior sex life, a new study shows.” See:
http://sciencenordic.com/male-circumcision-leads-bad-sex-life The AAP had time to include this study, but it was ignored. Others sent material to the AAP about CIRCUMserum, Senslip, foreskin restoration that men are undergoing to undo some of the damages of circumcision and how this improves the sexual experience for both men and women. It didn’t fit the AAP’s pro-circumcision agenda, so it was ignored. The Policy Statement is totally lacking in ethics, anatomy, and foreskin functions. Instead, the Task Force is more concerned with how to train more doctors to circumcise, and how to do so with different devices and various forms of anesthesia.

The physical and sexual harms from circumcision are minimized or dismissed outright. Deaths from circumcision and botched circumcisions are considered “case studies”, and the children horribly damaged from circumcision don’t merit the AAP’s consideration, even though the AAP’s alleged mission is that it is “Dedicated to the Health of All Children”. When cribs are faulty or car seats aren’t safe, the AAP becomes concerned and warns the public. When physicians botch circumcisions and are at fault, children don’t matter. After one botched circumcision lawsuit and a large settlement, the company that manufactured the Mogen clamp went out of business. The AAP report should have advised physicians to NOT use the Mogen clamp because of the botched circumcisions that have resulted with this device. If still in use, no doubt there will be future tragedies with the Mogen clamp, but parents will only be able to sue the doctor and hospital and not the manufacturer.

There was so much reliance on studies from Africa in this statement, that it seemed like the AAP should change its name to the African Academy of Pediatrics. In contrast to the AAP, the American Association of Family Physicians (AAFP) has stated: “…the association between having a sexually transmitted disease (STD) – excluding human immunodeficiency virus (HIV) and being circumcised are inconclusive…
most of the studies [of the effect of circumcision on HIV] …have been conducted in developing countries, particularly those in Africa.
Because of the challenges with maintaining good hygiene and access to condoms, these results are probably not generalizable to the U.S.
population”. But generalize the AAP did! In addition, the AAP listed page after page of STDs that allegedly circumcision would prevent, and wrote conflicting statements about syphilis. A recent study in Puerto Rico found that circumcised men have HIGHER rates of STDs and HIV. The 60% reduced risk of HIV following circumcision is the relative risk reduction, not the absolute risk reduction. There’s a huge difference.
Across all three female-to-male trials, of the 5,411 men subjected to male circumcision, 64 (1.18%) became HIV-positive. Among the 5,497 controls, 137 (2.49%) became HIV-positive”, so the absolute decrease in HIV infection was only 1.31%, which is not statistically significant.”
(Boyle GJ, Hill G. Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns. J Law Med 2011; 19:316-34.)

Infants are not at risk of STDs or HIV through sexual contact, so this speculation about their future risk is foolhardy. Infants can also be at risk for many other diseases, but surgical amputation of healthy body parts is a foolhardy approach for prevention and treatment of disease. If an infant is at risk of an STD, then it is probably safe to say that an adult is perpetrating a crime against the child and needs to be arrested and charged.

Judaism and Islam are mentioned as religions that practice religious circumcisions. Once again, the statement ignores Christianity, which teaches that circumcision is unnecessary. Christianity is the largest religion in the U.S., but its teachings don’t even get a mention by the AAP, which is rather insulting! With an over-representation of members on the Task Force who have a religious bias favoring circumcision, this is not surprising.

The AAP promotes parents choosing medically unnecessary circumcision for their male children, completely contradicting what it said in PEDIATRICS, Volume 95 Number 2, Pages 314-317, February 1995. It said then, “Thus “proxy consent” poses serious problems for pediatric health care providers. Such providers have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses. . . the pediatrician’s responsibilities to his or her patient exist independent of parental desires or proxy consent.”

Parents deserve factual information about circumcision, but they won’t find it in the new AAP Statement. In fact, the AAP wrongly advises parents of intact baby boys to retract the foreskin and wash it with soap and water. (page 763) Soap can alter the good bacteria under the foreskin, potentially causing infections that should then be treated with liquid acidophilus to restore the good bacteria. Water is sufficient for cleansing. Circumcised doctors with circumcised sons probably don’t know this.

On page 764, the AAP speculates that the foreskin contains a high density of Langerhans cells, “which facilitates HIV infection of host cells.” Actually, the exact opposite is true. “Langerin is a natural barrier to HIV-1 transmission by Langerhans cells” (Nature Medicine- 4 March 2007). This study states, “Langerhans cells (LCs) specifically express Langerin . . . LCs reside in the epidermis of the skin and in most mucosal epithelia, such as the ectocervix, vagina and foreskin.”

UTIs can be prevented through breastfeeding, which the AAP allegedly supports. This is nowhere mentioned under “Male Circumcision and UTIs”
on page 767. HPV can be prevented with a vaccine for both boys and girls, but it is not mentioned on that same page. A recent study reporting on the large number of re-circumcisions done following infant
circumcisions is also not even mentioned. On page 770, EMLA is
mentioned as a possible anesthetic, but EMLA is not supposed to be used on infants. The fact remains that unnecessary surgery performed with anesthesia is still unnecessary surgery.

There is so much wrong with this new statement that it should immediately be withdrawn before it is presented on Monday. The AAP should either start all over again (with new, unbiased Task Force members), or renew its 1999 statement which attempted to at least give a more balanced view of circumcision. The 1999 circumcision statement certainly had its flaws by ignoring ethics and the anatomy and functions of the foreskin, but it wasn’t as atrocious as this new statement is.

If the AAP wants to be regarded as a credible organization, it will look to the judgment of other foreign medical associations who recognize that circumcision is medically unnecessary and has serious ethical problems underlying its practice. American parents should look to these foreign medical associations for good advice, since the AAP is not providing it in its new statement.

Sincerely,
Petrina Fadel, Director
Catholics Against Circumcision

Part 2 : Sent to the AAP Board of Directors and the AAP Task Force Members on Aug 24, 2012 :

After rereading the AAP’s new Circumcision Statement, several more problems have emerged with this statement. This statement needs to be rescinded and withdrawn immediately! Others are becoming aware of this matter as well.

Under “Ethical Issues” (pages 758-759), two of the references for this opinion come from Dr. Douglas Diekema (AAP’s bioethicist), who signed his name to this statement. The rights of the child are totally ignored in this section, from an organization that claims to be concerned with the welfare of children but in this case isn’t. This is Diekema’s own personal opinion that the Task Force has bought into, based on what he wrote before. References are also taken from M.
Benatar and D. Benatar (both Jewish circumcision supporters), as well as from AR Fleishman (whom I suspect has a religious bias favoring circumcision). Under “Ethical Issues” (page 759), there’s an interesting choice of words by the AAP. “In cases, such as the decision to perform a circumcision in the newborn period, … and where the procedure is not essential to the child’s immediate well-being …” , the AAP admits here that circumcision “is not essential”. It even calls circumcision “elective” in several other places, but it then proceeds to do a massive sales pitch for this unnecessary surgery.

Under Ethics, Reference #14 comes from the British Medical Association- “The law and ethics of male circumcision: guidance for doctors: J. Med Ethics 2004. The BMA did not print a favorable piece on circumcision, but the AAP cherry-picked something from it on page 760. Medical associations in other countries, like the British Medical Association, do not promote circumcision as the AAP has so foolishly chosen to do.

On page 760, the AAP states, “The Task Force’s evidence review was supplemented by an independent, AAP-contracted physician and doctoral-level epidemiologist who was also part of the entire evidence review process.” Who was this? The AAP should reveal the name of this physician.

Several times in the report, the AAP states (page 762), “For parents to receive nonbiased information about male circumcision in time to inform their decisions…clinicians need to provide this information at least before conception, and/or early in the pregnancy, probably as a
curriculum item in childbirth classes.” There is absolutely no way
doctors can do this before conception, and “Inform their decisions” is code for brainwashing parents as early as possible. This is mind control at its worst, supported by the AAP!

The AAP on page 763 uses the term “Uncircumcised” under “Care of the Circumcised Versus Uncircumcised Penis”, and later the term “non-circumcised” when saying, “The non-circumcised penis should be washed with soap and water.” The correct terminology is intact penis, or normal or natural penis. We don’t say “uncircumcised” female or “non-circumcised” female.

The APP on page 764 states, “Mathematical modeling by the CDC shows that, taking an average efficacy of 60% from the African trials, [Note:
This is the relative risk, not absolute risk, which is 1.31%.) and assuming that protective effect of circumcision applies only to heterosexually acquired HIV” …” The AAP states here that they are assuming, which means to “suppose to be the case, without proof.”
There’s a saying that if you “assume” anything, it makes an ass out of u and me. Assumptions are not evidence, and since when should the AAP be relying upon or making assumptions? “Sexual Satisfaction and Sensitivity” (page 769) never once mentions or considers how circumcision impacts the sexual experience for females. The AAP gets it totally wrong about males, while then totally ignoring females! A Danish study by Morten Frisch (whom the AAP uses as a reference in
#118) revealed late last year that circumcised men have more difficulties reaching orgasm, and their female partners experience more vaginal pains and an inferior sex life.

“Analgesia and Anesthesia for a Circumcision After the Newborn Period”
(page 771) states, “Additional concerns associated with surgical circumcision in older infants include time lost by parents and patients from work and/or school.” The AAP is promoting newborn circumcision so parents don’t have to miss work? Parents miss work all the time when their kids get sick as toddlers or later on as young children. Now, all of a sudden, the AAP is concerned about parents missing work, but not concerned about the rights of the child.

Under “Complications and Adverse Events” (page 772), the AAP twice mentions how circumcision risks are lower in hospitals with trained personnel than those performed by untrained practitioners in developing countries. U.S. parents don’t live in a developing country, and this doesn’t even belong in an AAP statement!

“The true incidence of complications after newborn circumcision is unknown …” (page 772) “Two large US hospital-based studies with good evidence estimate the risk of significant acute circumcision complications … ” “(T)here are no adequate studies of late complications in boys undergoing circumcision in the post-newborn
period; this area requires more study.” (page 773) “There are not
adequate analytic studies of late complications in boys undergoing circumcision in the post-newborn period.” (page 774) Under “Stratification of Risks” the AAP says, “Based on the data reviewed, it is difficult, if not impossible, to adequately assess the total impact of complications, because the data are scant and inconsistent regarding the severity of complications.” After admitting that the true incidence of complications is unknown (i.e. the risks), the AAP then has the audacity to state that “the health benefits of newborn male circumcision outweigh the risks”. (page 756). Under “Task Force Recommendations” (page 775), the AAP says, “Physicians counseling families about elective male circumcision should assist parents by explaining, in a nonbiased manner, the potential benefits and risks …” The AAP doesn’t know the incidence of risks, so how do they expect physicians to know that?

The AAP sings its own praises under “Medical Versus Traditional Providers”. “Physicians in a hospital setting generally have fewer complications than traditional providers in the community setting.”
Was this the AAP saying that doctors are safer than mohels? I don’t think they’ll like that!

In 2009, ten years after the AAP did not recommend circumcision (and still doesn’t apparently, doesn’t on its words on page 585, but which one would never know after wading through this rubbish), their own survey of AAP members found that “18% responded recommending to all or most of their patients’ parents that circumcision be performed.” (page
776) I don’t find that surprising that AAP doctors would recommend a surgery that means more money for them. On pages 777-778 the AAP wants to know about the effectiveness of their new 2012 statement to mislead parents. “The Task Force recommends additional studies to better understand … The impact of the AAP Male Circumcision policy on newborn male circumcision practices in the United States and elsewhere.” In other words, how effective are we in deceiving American parents and people in other countries?

The AAP wants to work with the ACOG, AAFP, American Society of Anesthesiologists, and American College of Nurse Midwives to develop a plan about which groups are best suited to perform newborn male circumcisions. (page 777) In other words, how is the AAP going to divvy up the money it so eagerly wants?

The AAP targets blacks and Hispanics in the U.S. for unnecessary circumcisions. “African-American and Hispanic males in the United States are disproportionately affected by HIV and other STIs, and thus would derive the greatest benefit from circumcision.” (page 777) But then, under Areas for Future Research, the AAP says, “The Task Force recommends additional studies to better understand … The impact of male circumcision on transmission of HIV and other STDS in the United States because key studies to date have been performed in African populations with HIV burdens that are epidemiologically different from HIV in the United States.” The AAP just spent several pages before this promoting newborn circumcision to allegedly prevent STDs and HIV based on African studies, but now it’s admitting that more studies are needed because the results could be different in the U.S. Was this put in to help with the solicitation for more funding for pro-circumcision researchers at Johns Hopkins and elsewhere, to keep them going? Maybe these researchers are tired of Africa and want to come home?

The AAP did actually say ONE good thing, but only ONE good thing in this whole statement. On page 760 the AAP says, “The Task Force advises against the practice of mouth-to-penis contact during circumcision, which is part of some religious practices, because it poses serious infectious risk to the child.” If I were to guess, I’d say that perhaps Dr. Susan Blank put that in. While working for the New York City Health Department, Dr. Blank has done nothing to ban metzitah b’peh, so as not to offend the Orthodox Jews who practice it.
Babies have died of herpes from metzitzah b’peh under her watch.

This atrocious AAP Statement needs to be rescinded immediately. I suggest that the AAP use good judgment and do precisely that.

18 thoughts on “Pediatric Response by Petrina Fadel”

I found troubling this: “The majority of severe or even catastrophic injuries are so infrequent as to be reported as case reports (and were therefore excluded from this
literature review). These rare complications include glans or penile amputation,
198–206 transmission of herpes simplex after mouth-to-penis contact by a mohel (Jewish ritual circumcisers) after circumcision,207–209 methicillinresistant
Staphylococcus aureus infection, 210 urethral cutaneous fistula,211 glans ischemia,212 and death.213”

They absolutely IGNORED any information on the more severe complications of circumcision because they are just “case reports”. Hmm, how many cases of impurity is needed in a medication before it’s recalled, how many incidents are needed with any product that can affect a child before it’s recalled. But to deny analyzing this issue just because it’s reduced to case studies…

When they refer to the African studies linking HIV and “lack of circumcision”, of course at the same time they ignore any study that did not match that result, like the one from Puerto Rico that found more prevalence of HIV among circumcised males, or the one from the NAVY that found no correlation between circumcision and HIV among people in the NAVY, or any analysis of the difference with Europe. Perhaps the methodology is different as those were not experiments.

One question that they never seem to ask is: are there benefits to not being circumcised? Because, when weighing the potential benefits and the possible risks, what are the benefits of not performing the intervention? This question alone would completely change the balance of the ethic dilemma in my opinion.

And what follows from there is the lack of analysis as to why some (or so many) men are unhappy about being circumcised. Those men are the children that the AAP should have protected 20 and 30 and 40 years ago. Today, thanks to the internet, they are speaking out and stating that they wish this had not been done to them. Isn’t that information essential to debate the future of the procedure? Or do they reduce the foreskin to a price tag and completely dismiss the person who had it?

The policy also states that “parents are granted wide latitude in terms of the decisions they make on behalf of their children, and the law has respected those decisions except where they are clearly contrary to the best interests of the child or place the child’s health, well-being, or life at significant risk of serious harm” Well, what if circumcision does place the child’s health, well-being and life at significant risk of serious harm? How do they define “significant”? Because the severe risks were ignored because they were case studies, so they must be insignificant, right?

It also says that If the US is a “pluralistic society of the United States, where parents
are afforded wide authority for determining what constitutes appropriate child-rearing and child welfare”, but why is it that the only healthy tissue that can be legally removed for non-therapeutic reasons, whether by a doctor or religious practicioner is the foreskin? Why is the foreskin not granted the same protection as, say, the tip of the nose, the lips, the skin of the fingers, the clitoral hood? Is it really just a matter of having a health benefit to justify it when the individual does not have the ability to consent? Or is this “pluralistic” adjective a hint to come back in a couple of years an recommend the ritual nick on infant girls as an alternative to female genital mutilation, like they did in 2010?

What they never discuss is if an imposed circumcision can the violate human rights of the baby, and I think that was the most important question. In lack of that answer, potential health benefits and minimized risks are just a distraction. Candy coating the issue. It will give us something to talk about. We can discuss benefits and risks all day long, and in doing it we forget that we are talking about a human rights issue, about an unneeded and irreversible amputation performed on a vulnerable individual who is incapable to voice his consent or lack of. Which is evidenced in this malicious statement: “Newborn males who are not circumcised at birth are much less likely to elect circumcision in adolescence or early adulthood.” Not only that states that most men would not elect to get circumcised if given the chance, but they use it to leverage it against the baby by pressing the parents: “do it to him now while you have the chance because he won’t want it done later”.

Oh and on this: “The Task Force advises against the practice of mouth-to-penis contact during circumcision” – They make it sound like they don’t recommend it JUST during circumcision, which is to say that at any other time it would be just fine right? Or do we just need to type a big “duh” after the statement. Or should they extend it to say “during circumcision – and at any other time”.

That is a great article, which includes a great deal of what is left out of the most recent statement of the only medical group in the world that recommends cutting up the healthy, normal, genitalia of children. It is very obvious that these guys were determined to come to that conclusion and didn’t WANT to know the facts about it. American physicians who are circumcised and have all ready stripped and cut off the foreskins of newborns do not want the facts about it. They only want to find excuses to protect themselves from having to face the fact that something that is wrong on so many levels has been done.

If I could draw, I would draw a cartoon that would show a physician surrounded by all of the circumcised Americans who have contracted HIV, shouting at him that circumcision has not protected them. The physician would have his hands over his ears, blocking out the noise. He’d be standing on his tiptoes and searching across the ocean, hoping to find an isolated group of people who don’t circumcise infants whose rates of HIV are higher than another isolated group which does. The physician would then say, “AHA! I knew if we looked hard enough, we could find something to use as an excuse!”

If they honestly wanted to know how circumcision affects the rates of HIV for Americans, they would look at our own rates, and compare them with other countries whose standard of living, access to health care, standards of hygiene, and access to the facilities to achieve it, diet, access to contraceptive devices, etc. are similar to our own. That would include other industrialized nations of the world. Of those, a few others have some circumcised citizens, but the majority have essentially no circumcised men or boys. Only one, the USA, has a mostly circumcised population and yet, we have some of the highest rates of
HIV, as well as other disease that these people claim that circumcision prevents!

Its just really very, very sad, that people who are supposed to aleviate pain and suffering in children insist on finding excuses to INFLICT pain and suffering on tiny babies. Americans have no problem seeing even the simplest forms of female circumcision as barbaric and disgusting, and we don’t care what the reasons are that some people want to do that. Why can’t Americans see that cutting a baby boy’s genitals is no different?

thanks for reposting and thanks for having those links to the D. O. C. material, I’ve reposted those all over today. I did add a Part 1 to this post after you commented. I put as comments on your blog but feel free to reconfigure if it makes more sense to post as a proper post. Thanks for your partnership.

The AAP’s mind is made up — don’t confuse them with the facts! Just kidding. But that is certainly the mentality behind their new statement, and I suspect it might keep them from giving your letter its deserved attention or even reading it at all. I will still keep my fingers crossed that someone from the AAP has the decency to read your statement in its entirety, and the guts to stand up and spread the word before Monday. But the situation looks bleak.

Thank you for writing this letter. I thought about writing one, but I wouldn’t even know where to begin! We Americans should be embarrassed to have such a misinformed and backwards medical institution speaking on behalf of our children.

Excellent critique. I salute you Petrina. What a shameful manipulation of the facts. The AAP task force is IMHO morally bankrupt. Thanks for bringing my attention to something that should have occurred to me; that all of them are circumcised and naturally will vouch that it did them no harm and is a benign procedure. Circumcision is the theft that keeps on thieving. The life that I should have led was stolen from me by my circumciser.

I could not agree more. I consider what was done to me genital mutilation. This is a barbaric, tribal practice that should not be allowed to continue in this day and age. Muslims and Jews may cry out that we are antisemitic or Islam-aphobic, (a delicious irony that they should be bed-fellows on this issue), or insensitive to their cultural traditions. To this I would proudly say, “So what?” “What your doing to these infants is wrong and you can’t do it here any longer.
The AAP, is just out to keep a lucrative procedure on the menu, as it were.

Petrina, the AAP Policy Statement is exactly fitted to its purpose. Circumcision has enough health benefits for it to be covered by insurance, but just not quite enough for the AAP to routinely recommend it. In other words, the professional mutilators get to keep the money and avoid the lawsuits.

Observe also that throughout the Statement, the rights or feelings of the child are never considered. He is merely a commodity to be exploited for gain.

Robert, I think you are spot on. I’ve seen this in obstetrics. Doctors cook up research that doesn’t hold any water so they can distance themselves from lawsuits. I’m thinking here of the research that shows that cerebral palsy is not caused by forceps and vacuum extractors (everyone knows it’s the biggest cause) but, rather, that CP can develop weeks earlier in the womb with no apparent cause.

We’ve been wondering if the U.S. being the only place in the western world that is so perverse about justifying genital mutilation could be doing it out of cultural or religious bias. I don’t think that is the reason now. I think it’s coming out of the fact that bigger and bigger settlements are being awarded by the courts and the intactivist lawyers are winning the cases. It’s not a big stretch to imagine that the AAP is going to be overwhelmed by lawsuits as more and more parents keep their kids intact and the merits of keeping the foreskin are learned. Gloria